Paramedic CAT (Critically Appraised Topic)

005 | In a pediatric out-of-hospital cardiac arrest, when should the AED be applied?

Case Study

You respond to a 6yom in cardiac arrest. As you approach the patient, bystanders report that the patient was found unresponsive in a backyard pool with no evidence of trauma. Bystander CPR is being provided to a reasonable quality, and is being excellently-coached by a Dispatcher. The patient is previously healthy.

After oxygenation/ventilation and chest compressions, should the paramedic crew prioritise transport or remain on scene to attach an AED and analyse?

PICO Question

“In Pediatric OHCA, does on route application of Automated External Defibrillator versus on scene application of Automated External Defibrillator lead to neurologically favourable survival?”

Search Strategy

Limited to “since 2015” to be relevant to current ILCOR guidelines 

Pubmed: (Pediatric/Paediatric) AND ((AED) OR (Defibrillation)) AND ((OHCA) OR (out of hospital))

Google Scholar: (Pediatric/Paediatric) AND (AED) OR (Defibrillation) AND (OHCA) OR (out of hospital)

Search Outcome

20 Results (3 Relevant) on 2019-12-15

Clinical Bottom Line

Appraisal of the literature is consistent with ILCOR guidelines, in that cardiac arrest among infants and children is typically caused by progressive tissue hypoxia and acidosis as the result of respiratory failure and/or shock.  As these etiologies are not correctable by defibrillation, oxygenation/ventilation, chest compressions and transport should be prioritized.  If there is a history of blunt trauma to the chest, electrocution or the patient has a cardiac history, oxygen and CPR are still the priority, but paramedics should apply the AED with greater urgency as these patients may demonstrate a shockable rhythm. 

Relevant Papers

1. Fuchs SR, Kannankeril PJ. Out-of-hospital cardiac arrest due to ventricular fibrillation in children-A call to action. 2018. [LINK]
2. Fukuda T, Ohashi-Fukuda N, Kobayashi H, et al. Public access defibrillation and outcomes after pediatric out-of-hospital cardiac arrest. 2017. [LINK]
3. Silka MJ, Kobayashi RL, Hill AC, Bar-Cohen Y. Pediatric survivors of out-of-hospital ventricular fibrillation: Etiologies and outcomes. 2018. [LINK]

Additional References

1. Naim MY, Burke RV, McNally BF, et al. Association of Bystander Cardiopulmonary Resuscitation With Overall and Neurologically Favorable Survival After Pediatric Out-of-Hospital Cardiac Arrest in the United States: A Report From the Cardiac Arrest Registry to Enhance Survival Surveillance Registry. 2017. [LINK]
2. Sutton RM, Case E, Brown SP, et al. A quantitative analysis of out-of-hospital pediatric and adolescent resuscitation quality--A report from the ROC epistry-cardiac arrest. 2015. [LINK]
3. Goto Y, Funada A, Goto Y. Duration of Prehospital Cardiopulmonary Resuscitation and Favorable Neurological Outcomes for Pediatric Out-of-Hospital Cardiac Arrests: A Nationwide, Population-Based Cohort Study. 2016. [LINK]
4. Martinez PA, Totapally BR. The epidemiology and outcomes of pediatric in-hospital cardiopulmonary arrest in the United States during 1997 to 2012. 2016. [LINK]
5. Andersen LW, Raymond TT, Berg RA, et al. Association Between Tracheal Intubation During Pediatric In-Hospital Cardiac Arrest and Survival. 2016. [LINK]
6. deCaen AR, Garcia Guerra G, Maconochie I. Intubation During Pediatric CPR: Early, Late, or Not at All? 2016. [LINK]
7. American Heart Association. Web-based Integrated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - Part 11: Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality. 2020 [cited 2019-12-15] [LINK]
8. Atkins DL, Berger S, Duff JP, et al. Part 11: Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. 2015. [LINK]
9. Olasveengen TM, de Caen AR, Mancini ME, et al. 2017 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Summary. 2017. [LINK]
10. Cardiopulmonary Resuscitation Feedback Devices for Adult Patients in Cardiac Arrest: A Review of Clinical Effectiveness and Guidelines. 2015. [cited 2019-12-15] [LINK]
11. Zimmerman E, Cohen N, Maniaci V, Pena B, Lozano JM, Linares M. Use of a Metronome in Cardiopulmonary Resuscitation: A Simulation Study. 2015. [LINK]
12. Cheng A, Brown LL, Duff JP, et al. Improving cardiopulmonary resuscitation with a CPR feedback device and refresher simulations (CPR CARES Study): a randomized clinical trial. 2015. [LINK]
13. Austin AL, Spalding CN, Landa KN, et al. A Randomized Control Trial of Cardiopulmonary Feedback Devices and Their Impact on Infant Chest Compression Quality: A Simulation Study. 2020. [LINK]
14. Lin Y, Cheng A, Grant VJ, Currie GR, Hecker KG. Improving CPR quality with distributed practice and real-time feedback in pediatric healthcare providers - A randomized controlled trial. 2018. [LINK]
15. Jiang J, Zou Y, Shi W, et al. Two-thumb-encircling hands technique is more advisable than 2-finger technique when lone rescuer performs cardiopulmonary resuscitation on infant manikin. 2015. [LINK]
16. Fukuda T, Ohashi-Fukuda N, Kobayashi H, et al. Conventional Versus Compression-Only Versus No-Bystander Cardiopulmonary Resuscitation for Pediatric Out-of-Hospital Cardiac Arrest. 2016. [LINK]
17. Atkins DL, de Caen AR, Berger S, et al. 2017 American Heart Association Focused Update on Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. 2018. [LINK]